Vol 4-2 Research Article

Evaluating the Changes in Sagittal Balance via EOS Imaging before and after Total Hip Arthroplasty

Background and Aim: Sagittal imbalance is often presented as one of the major problems in individuals suffering from orthopedic pain, particularly those affected by destructive hip joint osteoarthritis. In this regard, total hip arthroplasty (THA) as a therapeutic procedure for such patients has resulted in the restoration of sagittal balance. Therefore, the present study aimed to evaluate the changes in sagittal balance using EOS imaging before and after THA and also reflect on its effect on hip joint function, knee pain, and disability percentage due to low back pain (LBP).

Methods: Utilizing a prospective cohort study, a total number of 24 patients suffering from extreme unilateral hip osteoarthritis and in need of unilateral THA were selected based on the inclusion and exclusion criteria, and then, sagittal balance parameters, including pelvic incidence (PI), pelvic tilt (PT), sacral slope (SS), sacrofemoral angle (SFA), sacrofemoral distance (SFD), lumbar lordosis (LL), and stem angle (SA) were investigated after performing standing radiographs by means of the EOS device. One year after THA, all the above-mentioned parameters were also measured by EOS imaging before and after the surgery and the patients completed some questionnaires, which is the Oswestry Low Back Pain Disability Index (OLBPDI) to evaluate disability percentage resulting in LBP, the Knee Injury and Osteoarthritis Outcome Score (KOOS) instrument to assess knee pain, and the Harris Hip Score (HHS) measure to rate hip joint function, and then the results were analyzed using the SPSS Statistics software (ver. 17).

Results: The patients consisted of 13 males (54.2%) and 11 females (45.8%) with the mean age of 52.87±13.05. The mean score of the preoperative PI was also equal to 54.74±10.66 and it was 58.19±11.58 after the surgery (p=0.025). However, the mean values of other parameters at the preoperative stage did not show any significant changes. As well, hip joint function and knee pain resulting from LBP improved in the patients after the surgery (p<0.001).

Conclusion: The study findings demonstrated that THA probably influenced sagittal balance through PI. Moreover, the postoperative hip joint function, knee pain, and disability percentage caused by LBP significantly enhanced compared with those before the surgery. Thus, it was concluded that the evaluation of sagittal balance parameters could help patients with orthopedic pain.

DOI: 10.29245/2767-5130/2023/2.1164 View / Download Pdf
Vol 4-2 Research Article

Perceptions on Sexual Activity after Total Knee and Total Hip Arthroplasty: A Mixed Method Study of Patients, Partners, and Surgeons

Background: In-depth insight into couples’ experiences of sexual activity before and after total hip arthroplasty (THA) and total knee arthroplasty (TKA) is lacking. The aim of this study was to explore patients’ and partners’ experiences, complemented by surgeons’ opinions on safe resumption of sexual activity after surgery.

Methods: Mixed method study: 1) Semi-structured interviews among sexually active couples, 1.5 years postoperatively and 2) A survey among surgeons about recommendations of sexual activity after THA/TKA.

Results: Of the 150 invited couples, 90 (60%) responded (THA: n=39; TKA: n=42). Five couples participated (THA: n=3; TKA: n=2), while 85 (94%) couples refused participation. Two themes emerged: “Couples physically and mentally adjusted to the new situation” and “Couples undoubtedly trusted the surgeon as the provider of information.” In total, 27% (47/175) of THA surgeons participated. Fifty percent agreed with the recommended sexual positions researched by Charbonnier et al. Opinions differed widely regarding when to safely resume sexual activity. Of the TKA surgeons, 36% (76/211) responded. Almost all surgeons (95%) agreed that there were no restrictions. However, some discomfort was expected when patients bend the knee or kneel during sex. Half of the surgeons indicated that providing information about sex was necessary.

Conclusions: All couples physically and mentally adapted to the new situation without considering safety measures. Patients trusted surgeons in providing safety information. Surgeons should inform patients succinct and explicitly, especially since surgeons’ recommendations showed great variability. More motion research on hip and knee may add to uniform guidelines.

DOI: 10.29245/2767-5130/2023/2.1181 View / Download Pdf
Vol 4-2 Review of Literature

The Implications of Obesity on Total Hip Arthroplasties: A Literature Review of the Associated Complications

Introduction: Obesity is a global pandemic and public health crisis associated with a wide range of comorbidities, including osteoarthritis, leading to a significantly younger age at the time of primary total hip arthroplasty (THA) and an increased rate of complications compared to nonobese individuals. As our population continues to get older, combined with an increasing rate of obesity, an increased rate of consultations for total hip arthroplasty is expected. This has led to concerns regarding the implications of obesity on the need for THA itself and the associated complications, especially for arthroplasty surgeons. Unfortunately, few articles provide an all-encompassing review of different complications surrounding obesity within orthopedic surgery, and even fewer around total hip arthroplasty. This literature review aims to provide a comprehensive review of the implications obesity has on total hip arthroplasties, its associated complications, and how we can potentially modify these risks.

Methods: Sources and research articles were identified by searching the databases of PubMed, Google Scholar, and the National Center for Biotechnology Information (NCBI) from 2000 to July 2022. Our search used the specific terms located within the abstract/title, including: “total hip arthroplasty” AND “complications,” AND “obesity, OR obese.” Inclusion criteria for research articles were the English language and peer-reviewed articles published from inception to July 2022. Articles not directly examining the effect of obesity on the incidence of complications following primary THA were excluded. Studies with outcomes of interest included the incidence of postoperative complications, primary THA in obese patients, and clinical outcome measures. A total of 265 studies were identified upon initial search. Thirty-one articles were selected for reference in this literature review.

Results: Obese patients undergo primary THA at an earlier age and experience an increased duration of surgery, higher rates of infection, dislocation, periprosthetic fractures, and venous thromboembolism compared to nonobese patients. The role of pre-operative bariatric surgery before total hip arthroplasty has failed to show reductions in complication rates. Harris Hip Scores are lower in obese patients pre-operatively and post-operatively, but the degree of improvement following THA is similar compared to nonobese patients. Long-term survival of total hip prostheses is similar when compared to nonobese patients.

Conclusion: Current literature strongly suggests increased complication rates in obese patients who undergo THA. This phenomenon is not solely due to biomechanical forces and is multifactorial, including inflammatory and genetic predispositions, which need further study. The decision to perform THA on obese patients should not solely be based on BMI. Other factors, such as management of comorbidities, surgical exposure, and nursing care, should be considered when deciding on surgical candidacy.

DOI: 10.29245/2767-5130/2023/2.1184 View / Download Pdf